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Carpal Tunnel Syndrome - Symptoms & Treatment

Carpal tunnel syndrome (CTS) is the condition that results from pinching of one of the nerves in the wrist and hand. The most common of the nerve entrapment syndromes, carpal tunnel syndrome results from compression of the median nerve at the wrist, within the carpal tunnel. This nerve passes through, along with blood vessels and flexor tendons, to the fingers and thumb. The compression neuropathy causes sensory and motor changes in the median distribution of the hand. Carpal tunnel syndrome usually occurs in women between ages 30 and 60 and poses a serious occupational health problem. Assembly-line workers and packers, secretarytypists, and persons who repeatedly use poorly designed tools are most likely to develop this disorder. Any strenuous use of the hands-sustained grasping, twisting, or flexing-aggravates this condition.

Almost 8 million Americans have CTS. Kids can get it, too, but it's not as common. Most people who get CTS are over 30, and more women than men have it. In fact, three times as many women as men have CTS. Computer operators, assembly-line workers, and hair stylists are at risk because they repeat the same hand movements over and over again.

Causes

The carpal tunnel is formed by the carpal bones and the transverse carpal ligament. Inflammation or fibrosis of the tendon sheaths that pass through the carpal tunnel often causes edema and compression of the median nerve.

Many conditions can cause the contents or structure of the carpal tunnel to swell and press the median nerve against the transverse carpal ligament.

Such conditions include rheumatoid arthritis, flexor tenosynovitis (often associated with rheumatic disease), nerve compression, pregnancy, renal failure, menopause, diabetes mellitus, acromegaly, edema following Colles' fracture, hypothyroidism, amyloidosis, myxedema, benign tumors, tuberculosis, and other granulomatous diseases. Another source of damage to the median nerve is dislocation or acute sprain of the wrist.

Signs and symptoms

• The patient with carpal tunnel syndrome usually complains of weakness, pain, burning, numbness, or tingling in one or both hands. This paresthesia affects the thumb, forefinger, middle finger, and half of the fourth finger.
• The patient is unable to clench his hand into afist. The nails may be atrophic; the skin, dry and shiny.
• Trouble gripping objects.
• The pain may spread to the forearm and, in severe cases, as far as the shoulder.
• Weakness in your thumb.
• Symptoms at night are common and may awaken you from sleep. During the day symptoms frequently occur with holding a phone, reading or driving.
• A sense of weakness in your hands, and a tendency to drop objects.

Diagnosis

Physical examination reveals decreased sensation to light touch or pinpricks in the affected fingers. Thenar muscle atrophy occurs in about half of all cases of carpal tunnel syndrome.

The patient exhibits a positive Tinel's sign (tingling over the median nerve on light percussion). He also responds positively to Phalen's wrist-flexion test (holding the forearms vertically and allowing both hands to drop into complete flexion at the wrists for 1 minute reproduces symptoms of carpal tunnel syndrome).

A compression test supports this diagnosis: A blood pressure cuff inflated above systolic pressure on the forearm for 1 to 2 minutes provokes pain and paresthesia along the distribution of the median nerve.

Electromyography detects a median nerve motor conduction delay of more than 5 msec. Other laboratory tests may identify underlying disease.

Treatment

Conservative treatment should be tried first, including resting the hands by splinting the wrist in neutral extension for 1 to 2 weeks. If a definite link has been established between the patient's occupation and the development of carpal tunnel syndrome, he may have to seek other work. Effective treatment may also require correction of an underlying disorder.

When conservative treatment fails, the only alternative is surgical decompression of the nerve by resecting the entire transverse carpal tunnel ligament or by using endoscopic surgical techniques. Neurolysis (freeing of the nerve fibers) may also be necessary. Try to alternate tasks so that you don't spend more than one to two hours at a time doing one that involves your hands.

• Use a wrist support pad with your computer keyboard to help maintain the straight alignment of your wrist.
• Apply ice or a cold pack to the palm side of the wrist for five to ten minutes as needed.
• Gently warm up your hands before starting work. Do some wrist circles and stretch your fingers and wrists.

Complementary and alternative medicine

Yoga and other relaxation techniques may help with chronic pain that occurs with some muscle and joint conditions. Yoga postures designed for strengthening, stretching and balancing each joint in the upper body, as well as the upper body itself, may help reduce the pain and improve the grip strength of people with carpal tunnel syndrome.

Dietary Changes

Dietary changes can provide the body with the necessary nutrients needed to repair nerves and help reduce inflammation. With this, pressure on the nerve can be reduced, thus allowing it to heal. Certain vitamins and nutrients can also be taken to repair nerve damage, such as amino acids , vitamin B complex and hypercium (an extract of St. John's wort ). No specific vitamin or nutrient has been shown to have a noticeable anti-inflammatory effect, but taking a diverse multivitamin may have a noticeable effect on reducing inflammation in the body. One could argue that diet and vitamins have a small effect on carpal tunnel syndrome, similar to placebo. Their effect would certainly be negligible in anything but the most mild of cases.

Prevention

There are no proven strategies to prevent carpal tunnel syndrome, but to protect your hands from a variety of ailments, take the following precautions:

• Keep your hands warm:- You're more likely to develop hand pain and stiffness if you work in a cold environment. If you can't control the temperature at work, put on fingerless gloves that keep your hands and wrists warm.
• If you do the same tasks with your hands over and over, try not to bend, extend or twist your hands for long periods.
• Advise the patient who is about to be discharged to occasionally exercise his hands. If the arm is in a sling, tell him to remove the sling several times a day to do exercises for his elbow and shoulder.
• Encourage the patient to use his hands as much as possible. If his dominant hand has been impaired, you may have to help with eating and bathing.
• Make sure your tools aren't too big for your hands.
• Lose weight if you're overweight.
• Take regular breaks from repeated hand movements to give your hands and wrists time to rest.
• Avoid sleeping on your hands.